Guess Health Care can get worse!

[plugger]

Ryan turns knife on Medicare, Medicaid

By Margaret Flowers, MD
FireDogLake, April 6, 2011

Rep. Paul Ryan of Wisconsin, the Republican chairman of the U.S. House Budget Committee, unveiled two proposals this week which if enacted would constitute a mortal threat to our nation’s health – particularly to the health of our seniors and our most vulnerable populations.

The first proposal, Senate Joint Resolution 10, would amend the Constitution by imposing rigid and arbitrary restraints on federal spending. The second, his fiscal year 2012 federal budget resolution (misleadingly and eerily called “The Path to Prosperity”), would essentially kill the Medicare program and gut Medicaid, among its other nasty effects.

Both proposals should be emphatically rejected.

Ryan clearly has health care on his hit list. He stressed the problem of health care costs during his final testimony to President Obama’s bipartisan National Commission on Fiscal Responsibility and Reform last December. He said then that he would borrow pieces of the commission’s report for the federal budget, but his latest proposals are in fact much more radical.

The Deficit Commission report stated that if the national health law did not control health care costs, then that ought to trigger more drastic changes in health care spending. Rather than wait for a trigger, Ryan is moving full steam toward the dismantling of our public health programs for the poor and elderly, and the creation of an even more fragmented, privatized and dysfunctional health care landscape than we have now.

Seniors to join the growing ranks of the under-insured

Ryan would change Medicare from a guaranteed benefit program to a limited spending program which pushes more seniors into the private market. Similar to the new federal health law, seniors would be given a defined amount of money that they could use to purchase private insurance on an exchange. Such subsidies are expected to grow more slowly than overall health care costs, so that as insurance premiums rise, seniors would be pushed into skimpier plans that would leave them unable to afford needed care and financially vulnerable should they have a serious accident or illness.

The dismantling and privatization of Medicare, which would be completed by 2022, would actually lead to higher overall health care costs and poorer health for our Medicare population. Health care costs would be higher because of the added private-insurer expenses of profit and inefficient administration. For example, Medicare Advantage plans, run by the insurers, currently cost about 10 times more to administer than the traditional Medicare program.

It is also possible that increased cost-sharing in the form of higher co-pays and deductibles would cause seniors to delay or forgo necessary care leading to greater costs on the back-end for a greater number of and lengthier hospitalizations. (In a darker, bone-chilling moment, one economist recently remarked that delayed care leading to early deaths results in reduced U.S. health spending.)

Further privatization of Medicare will also increase the fragmentation of our health care financing, which will weaken the program’s ability to negotiate fair prices for goods and services.

Ryan describes this change as similar to Medicare part D, for which he voted in 2003. This is another scary thought. The result of Medicare part D was greater confusion and obstacles for seniors, a huge new burden on taxpayers, and windfall profits for the pharmaceutical industry.

Medicaid will shrink in a time of growing need

Regarding Medicaid, Ryan proposes to change the federal portion of the program’s funding to block grants. This means that rather than deciding what part of the population qualifies for Medicaid and adjusting the amount of money allocated based on need, as we do now, states will instead receive a defined lump sum to use as they see fit.

This approach is misleadingly marketed as providing states with greater flexibility. However, Ryan also wants to cut Medicaid spending by $1 trillion over the next 10 years, which will effectively eliminate the Medicaid expansion envisioned under the federal health law and impose even more severe limitations on the number of people and services that will be covered.

In times of growing unemployment and poverty, with more people needing Medicaid, there will be fewer dollars and no guarantee that people will be able to enroll. This will effectively leave millions of our most vulnerable citizens unable to receive necessary services, leading to increased suffering and deaths.

Ryan seriously suggests that those who qualify for Medicaid should be put into the private insurance market in the mistaken belief that this will provide greater choice and cost efficiency. But this is ludicrous, given the well-known track record of the private insurers.

Correct diagnosis, wrong prescription

Ryan does get one thing right: he correctly observes that health care costs are intimately tied to our nation’s budget problems. Health care expenses are expanding way out of line with our economic growth. And yet for all of this spending, a third of our population is either un-insured or under-insured, the medical bankruptcy rate is high, and our health outcomes are relatively poor.

What Ryan fails to understand is that Medicaid and Medicare are not the cause of our rising costs, but rather are the victims of our broken health care system. Medicaid and Medicare costs are actually rising more slowly than our private sector costs. For more on this, see this summary from a congressional briefing on Medicare and the deficit.

Ryan’s plans mirror the austerity measures being pushed in many states across the country and represent an escalation of the worst proposals put forth by the bipartisan Deficit Commission. These growing threats to our social programs require that we step up our defense of the public health infrastructure and make an even louder case for an improved Medicare for all.

As for Ryan’s proposal for a constitutional amendment to cap federal spending, one wonders how much of it is driven by political grandstanding.

S.J.Res.10 would limit federal spending to 18 percent of the gross domestic product, something that hasn’t occurred since 1966. (It’s currently around 24 percent of GDP.) This may sound like a laudable goal until one realizes that during an economic downturn, as we are currently experiencing, there is a much greater need for government spending on programs such as food stamps, unemployment benefits and public health insurance.

A new, arbitrary ceiling on federal outlays could prove disastrous. Noted economist Joseph Stiglitz makes the case that a temporary increase in investment in public programs is required in a downturn in order to make economic recovery possible.

Rep. Ryan hinted at his true agenda during the final meeting of the Deficit Commission when he said that he liked discretionary caps. Significantly, his constitutional amendment would exempt military expenditures in times of war (a seemingly permanent condition for the U.S. today) from such caps.

Greater urgency to protect our right to health care

Section 4 of S.J.Res.10 is also a matter of concern, particularly for single-payer advocates. It states that any bill that raises taxes or imposes a new tax may only pass with a two-thirds majority vote in Congress. Because a national single-payer program would replace current health spending on insurance premiums and out-of-pocket expenses with a new, equitable, and progressive system of taxation to finance universal care, this undemocratic amendment would constitute another obstacle to enacting an improved Medicare for all.

Yet it is precisely single payer that’s the solution to our health care and economic crises: an improved and expanded Medicare-like system that covers everyone. This will achieve the goals of a universal, comprehensive health system which controls our health care costs, relieves businesses of the burden of providing health care coverage and provides a framework within which quality of care and health outcomes will improve. My testimony and that of others presented to the Deficit Commission last summer made that argument.

It is imperative that we take a strong stance to end this assault on our health. Speak to your elected officials today. Tell them to reject Ryan’s proposals. And tell them you want a real solution to our health care crisis: single-payer national health insurance as embodied in H.R. 676.

Margaret Flowers, M.D., is congressional fellow at Physicians for a National Health Program.

http://www.pnhp.org/news/2011/april/ryan-turns-knife-on-medicare-medicaid

[MooseMom]

For "vulnerable population", read "all of us here on IHD.

[Willis]

Mark Steyn: Ending Medicare, or ending America?
April 08, 2011

Hey, it's the weekend, and everyone's singing the same maddeningly catchy refrain! Rebecca Black's "Friday"? Nah, that was last week's moronic sing-along. This week's is even perkier! "Paul Ryan proposes to end Medicare as we know it," sings former Clinton chief of staff John Podesta. "It would end Medicare as we know it," sings Sen. Max Baucus of Montana. "It's going to end Medicare as we know it," sings Nadeam Elshami, communications director for Nancy Pelosi. "It does end Medicare as we know it," sings Sen. Tom Harkin of Iowa. "I drove all night to watch Paul Ryan e-e-end Me-edi-ica-a-are as we-e kno-o-o-o-o-o-o-o-o-w it," sing all 24 semifinalists on the Céline Dion round of "American Idol."

Sadly, Congresswoman Debbie Wasserman-Schultz, incoming chair of the Democratic National Committee, lost the sheet music and was forced to improvise. "This plan would literally be a death trap for seniors," she ululated. Close enough!

Ending Medicare as we know it? Say it ain't so! Medicare, we hardly knew ye! It's an open question whether Americans will fall for one more chorus of the same old song from Baucus, Harkin, Podesta and the other members of America's wrinkliest boy band. But, if this is the level on which the feckless patronizing spendaholics of the permanent governing class want to conduct the debate, bring it on:

Paul Ryan's plan would "end Medicare as we know it".

The Democrats' "plan" – business as usual – will end America as we know it.

Literally, as Rep. Wasserman-Schultz would say. One way or another, Medicare as we know it is going to end. So, if you think an unsustainable 1960s welfare program is as permanent a feature as the earth and sky, you're in for a shock. It's just a question of whether, after the shock, what's left looks like Japan or looks like Haiti.

My comrade Jonah Goldberg compares America's present situation to that of a plane with one engine out, belching smoke. But, if anything, he understates the crisis. Air America doesn't need a busted engine because it's pre-programmed to crash. Our biggest problem is Medicare and other "entitlements": They're the automatic pilot of Big Government. Whoever's in the captain's seat makes no difference: The flight is preprogrammed to hit the iceberg, if you'll forgive me for switching mass-transit metaphors in midstream.


 

[MooseMom]

 
Paul Ryan, GOP Get Turn On Medicare Hot Seat
 
RICARDO ALONSO-ZALDIVAR   04/11/11 06:33 AM ET   

WASHINGTON — Now it's their turn to try to fix the health care mess. Republicans, just like President Barack Obama, may discover that's easier said than done.

The GOP budget expected to go to the full House this week would remake health care programs for the elderly and the poor that have been in place for nearly half a century. Budget Committee Chairman Paul Ryan, R-Wis., says his approach would "save" Medicare by keeping the financially troubled program affordable for federal taxpayers.

But it turns out that people now 54 and younger would pay the price.

By one authoritative estimate, they'd be on the hook for most of their own health care costs after they become eligible for Medicare as retirees. The nonpartisan Congressional Budget Office says the typical beneficiary would be expected to pay more than two-thirds of his or her medical costs by the year 2030.

Costs wouldn't come down; they'd just get shifted.

"It's a political nonstarter," said health care consultant Robert Laszewski, a former insurance executive and strong critic of Obama's overhaul. "It kills Medicare as we know it, and that is simply too popular a program among seniors and their children."

Cue the Democratic political ads for the 2012 campaign.

Republicans may escape the full wrath of seniors, however, since the House budget isn't likely to get very far. It won't pass the Democratic-run Senate. House members can vote for the budget's tough medicine without having to dish it out before they run for re-election. But Democrats running against them in 2012 won't let voters forget the budget, just as Republicans hammered Democrats last year over Medicare cuts in Obama's health care law.

Whatever happens to his budget, Ryan's general idea that seniors should bear more direct responsibility for decisions that affect health care costs isn't going away.

Story continues below
Advertisement"If everybody who bought health care was paying more when they get a more expensive plan, that would create a lot more pressure to bring costs down," said Mark McClellan, who ran Medicare for President George W. Bush. "There's reason to think that reforms that engage beneficiaries in getting less costly care will make a difference."

The principle behind Ryan's plan is that seniors making their own decisions about health insurance can do a better job of keeping costs in check than Washington bureaucrats playing whack-a-mole with rising prices.

That's different from the approach in Obama's health care law, which relies on government to police the market and would deny insurers that jack up premiums the right to sign up customers who are receiving taxpayer subsidies.

The GOP budget "will preserve Medicare through competition among health plans for the business of millions seniors," said Ryan.

But would it work as envisioned?

Under Ryan's plan, Medicare would remain largely the same for current beneficiaries and people within 10 years of retirement. The biggest change for this group would be the revival of the "doughnut hole" gap in Medicare prescription coverage that Obama's health care law eliminated. (The GOP budget calls for repeal of the new law.)

Then, starting in 2022, new retirees would get a fixed amount of money to buy private insurance from a choice of plans regulated by the government. The sick would get more money, the wealthy less. The payment would be adjusted for inflation.

Ryan calls his approach "premium support." Critics call it the voucher plan.

The Congressional Budget Office analysis suggested the new system would start running into problems right away.

Buying the Medicare benefit package from a private insurer would turn out to be significantly more expensive. Medicare typically pays hospitals and doctors less than private insurance. Without some kind of effort to control private health care costs, the government contribution toward premiums wouldn't go very far.

"I don't believe you can pursue this approach for Medicare and not at the same time address the problem of cost growth in the private health care sector," said economist Robert Reischauer, a former budget office director. "To do so would result in a two-tier health care system." Reischauer says he's sympathetic to the voucher system in principle, just not this version.

Ryan had developed an earlier form of his proposal jointly with a prominent Democratic economist, Alice Rivlin, a former vice chair of the Federal Reserve. Although Ryan publicly cited her in unveiling his plan, Rivlin said she doesn't support this version.

The government health care payment in the GOP budget would quickly fall behind medical inflation, Rivlin said. "Ryan has lowered the growth rate so that it's really punitive," she added. Rivlin also says seniors should be given a choice between staying in traditional Medicare and a voucher system.

She also differs with Ryan on raising taxes. "You can't do it all on the spending side, because the cuts required are Draconian," Rivlin said.

Despite the political risks Republicans take with their Medicare remake, they won't get much in savings over the 10-year estimating window that Congress applies to the budget. It's because the shift to a new system doesn't come until 2022.

That's not the case with Medicaid. The health care program for the poor would be turned over to the states and spending cut by more than $700 billion over time.

Although the GOP's 2012 budget reduces total government spending by more than $5 trillion over a decade, that still wouldn't bring the federal budget into balance.

One of Obama's top advisers, David Plouffe, says the president this week will offer his own plan for reducing long-term spending. The details will come from Obama, Plouffe says, although the adviser acknowledges that cuts to Medicare and Medicaid will be necessary.

___

EDITOR'S NOTE – Ricardo Alonso-Zaldivar covers health care for The Associated

___

Online:

House GOP budget: http://budget.house.gov/fy2012budget/

Congressional Budget Office: http://www.cbo.gov/doc.cfm?index12128

[paul.karen]

Something has got to change.

Doesnt take a rocket scientist to see that with the baby boomers retiring there will be more people on medicare then there is paying into medicare.

Much like the talks over unions.  More people retired taking in large pensions then there are people working to pay the pensions of people no longer working.

Something has got to change.

[MooseMom]

Something has got to change.

Any company that wants a balanced budget has to look at both sides of the equation.  That company must cut costs and bring in more revenue.  So for those who believe that the government should also have a balanced budget, it follows that there must be spending cuts coupled with revenue increases.  So far, all that has been proposed is spending cuts.  This is not a logical way to balance a budget.  You must also seek ways to bring in more money, and sadly for our country, tax cuts for wealthy corporations and individuals have been continued and even maximized.  This simply does not make good fiscal sense.

Tax cuts for the wealthy have not lead to higher employment rates as we have been told would happen.  It is not true that wealthy people create jobs.  It is the middle class that historically has created jobs... the entrepreneurs, the innovators, the small business people.

So, creating a fairer tax system is something that can change.

Getting out of Afghanistan is something that can change. 

Reducing defense spending is something that can change, but the truth of THAT matter is that lots of congressment from BOTH parties have defense contractors in their districts.  A lot of people are employed in the manufacture of weapons and other materiel.  War is very profitable for some parts of our country.

If Paul Ryan is so "courageous" as he has been bizarrely touted, let see him advocate for his Medicare changes to commence in 2012 instead of 2022.

[Willis]

Any company that wants a balanced budget has to look at both sides of the equation.  That company must cut costs and bring in more revenue.  So for those who believe that the government should also have a balanced budget, it follows that there must be spending cuts coupled with revenue increases.  So far, all that has been proposed is spending cuts.  This is not a logical way to balance a budget.

It's really not that simple. Very few companies can just willy-nilly decide to "bring in more revenue." If these businesses are so greedy and unprincipled as some suggest then aren't they ALREADY maximizing their revenue? Any successful business person knows that raising prices (not revenue) may often backfire and actually reduce revenue (total gross income). And likewise, reducing prices can often increase revenue. That's Econ 101.

Government faces the same problem. A point comes where taxes get too high and then people take whatever steps necessary (even illegal ones unfortunately) to avoid taxes and then TOTAL REVENUE actually goes down. Taxes are the "price" of government services and people are going to react to tax/price increases by the government just like they do when the price of bread goes up at the grocery store.

Now if the only solution to this problem is to tax "the rich," then those are the very people who have the resources to flee to more favorable tax jurisdictions. The number of people expatriating right now has increased so much that many of these ex-pats have to wait for a year or more just to get an appointment with the local consular to sign their paperwork renouncing American citizenship.

Who do you think will get stuck with the bills? That's right...the middle class who can't afford to pickup and move. (The poor don't have any money by definition, so only the middle class has any money to pay taxes.) After a while then, EVERYONE is poor except the politicians.

Hmmm...as I proofread the above I just realized that Ayn Rand said all this already in "Atlas Shrugged." I just saved everyone about 1200 pages of heavy reading! 

 

[MooseMom]

 
   
Profiles in Cowardice: How the Beltway Punditocracy Gets Paul Ryan's Plan Totally Wrong
By Michael Grunwald Thursday, Apr. 07, 2011   

Correction Appended: April 8, 2011

You may not like Congressman Paul Ryan's budget plan, but you must admit that it's courageous. You simply must. By order of the Washington establishment, you may question whether Ryan's plan is sensible or humane or even remotely honest, but you have to confess that it is undeniably an extraordinary act of bravery, or else pundits will beat the confession out of you with swoony prose.

To New York Times columnist David Brooks, Ryan's 73-page budget outline — it's not an actual budget — is "the most comprehensive and courageous budget reform proposal any of us have seen in our lifetimes." Here at Time.com, Joe Klein wrote that it's "without question, an act of political courage," while Fareed Zakaria declared that "Ryan's plan is deeply flawed, but it is courageous." The Economist agreed: "Credit where credit is due; whatever you think of Paul Ryan's budget, it is politically gutsy."
(See "The Ryan Budget: A Test of Character for Obama.")

This is just weird. Ryan is a conservative Republican committee chairman in a conservative Republican caucus. He was reelected last year with 68% of the vote. Sorry, Joe, but I do question whether it was really courageous for him to propose huge tax cuts for the rich, squeeze health care for the poor, and promise that nobody over 55 — the heart of the conservative Republican base — will have to make any sacrifices. Honestly, does anyone think this week has been bad for Ryan's career?

It certainly would have been courageous — not Winston Churchill courageous, and certainly not running-into-a-burning-building or fighting-overseas courageous, but at least politically risky — for Ryan to veer off from the Republican party line to embrace tax increases. (GOP Sen. Tom Coburn has earned some bravery points there.) It might have been equally courageous, though less relevant to debt reduction, to revive President George W. Bush's idea of privatizing Social Security, which Ryan supported before it went down in flames in 2005. But there's a reason Social Security is known as the third rail of politics, and this time around, Ryan didn't touch it. One can only imagine the paroxysms of glee that would have erupted in Washington green rooms if he had.
(See TIME's Q&A with Paul Ryan on his ambitious budget.)

My point here is not to shred Ryan's plan, because others have done a good job of that. One critic noted that it makes "magical assumptions about growth," that "it's actually quite weak at outlining reductions in government spending," that the Congressional Budget Office has issued a "devastating critique" of Ryan's "highly unrealistic" proposals to control health costs. Actually, that was Fareed. An even harsher critique titled "Ryan the Fibberoo" accused him of "fudges and elisions, and the odd outright falsehood." That was the same Economist article that praised his guts.

I just don't understand what's so brave about fuzzy math in the service of Tea Party ideology. Ryan's plan certainly could become unpopular, but only if people realize what's actually in it. And he certainly isn't bragging about the elements that could alienate the public. For example, his plan would presumably require tax hikes on the middle class in order to achieve its stated goals of keeping revenue levels steady while slashing rates for high earners and corporations. But Ryan doesn't get into those details. To the extent that identifying specific and immediate cuts is politically courageous, House Republicans deserve far more credit for their insistence on slicing $61 billion in spending out of the current budget — at the risk of a government shutdown — than for Ryan's vague pledges about the distant future.
(See if Paul Ryan is too bold for the GOP.)

I don't blame Ryan for trying to put a positive spin on his plan, rather than acknowledging that it would abolish Medicare and replace it with subsidies that won't keep up with health inflation. People like Medicare. And I can understand why he'd open a budget negotiation with fantasy numbers that depend on 2.8% unemployment in 2021 and "dynamic scoring" that can't pass a laugh test, rather than real numbers that would require much tougher choices. It's smart politics. I just don't understand how it became the political equivalent of the bayonet charge at Fredericksburg.

Supposedly, Ryan is brave because he's willing to start an "adult conversation" about the deficit and entitlements in Washington. But politicians talk about the deficit and entitlements all the time. Some close observers of American politics may recall that President Obama proposed a health care bill last year; it included half a billion dollars in Medicare cuts, which Republicans attacked as vicious rationing that would pull the plug on Grandma. I don't recall a lot of David Brooks commentary about the courage of that plan, even though, unlike Ryan's, it had a chance of becoming law.
(See "Paul Ryan: The GOP's Answer to the 'Party of No.'")

Oh, wait: It did become law. And the Congressional Budget Office has concluded that repealing it would add $230 billion to the deficit.

Needless to say, Ryan's budget would repeal it. Courage!

Liberal bloggers argue that Ryan gets lionized because he's a Republican. But Joe Klein's no Republican; he's savaged the GOP as a party of nihilists. (He also ridiculed Ryan's plan for "massive political amnesia.") That said, the left has a point when it complains about the Washington consensus that raising taxes on the rich is crass populism and class warfare, while cutting services for the poor is fiscal responsibility and the hallmark of seriousness. There is a tendency in Washington to associate austerity for the masses with "straight talk" and "strong medicine," a yearning for politicians to stop giving their constituents candy and start delivering some long-overdue pain. In fact, Medicare and Medicaid, for all their cost challenges, are not candy. And few of us who are lucky enough to get paid to write about this stuff are in much danger of feeling much pain.
(See 10 elections that changed America.)

Anyway, it's strange to fetishize pain at a time of 9% unemployment; right now, the tepid recovery is by far the most serious problem for the short-term budget outlook. The existential threat to the Treasury in the medium term is the rising cost of health care; in fairness, Ryan has some ideas there, although most of his savings involve giving less health care to people who can't afford it on their own. Obama had some ideas, too, like taxes on high-value "Cadillac" insurance plans, a big push to computerize the medical records system, an independent commission that could rein in Medicare reimbursement policies, and pilot programs designed to reduce the expensive incentives of a fee-for-service system. Republicans dismissed it all as big-government rationing. Even Obama's plan to boost comparative research into what kind of medical treatments work best was attacked as a socialist plot to euthanize the elderly.

So by all means, let's have an adult conversation about deficits. A good place to start would be the origins of our current predicament. President Clinton left behind a huge budget surplus. As Joe pointed out, it was wiped out by President Bush's tax cuts, the wars in Iraq and Afghanistan and the Medicare Part D prescription drug benefit.

All of those budget-busters went on the national credit card. And all of them were supported, no doubt courageously, by Congressman Ryan.


(I don't understand why, when Obama spoke of Medicare cuts, he was labelled as heading a "death panel", whereas when Rep. Ryan advocates the same, he's hailed as "courageous".  How do you explain that?  Any ideas?)

[MooseMom]

Very few companies can just willy-nilly decide to "bring in more revenue." If these businesses are so greedy and unprincipled as some suggest then aren't they ALREADY maximizing their revenue? Any successful business person knows that raising prices (not revenue) may often backfire and actually reduce revenue (total gross income). And likewise, reducing prices can often increase revenue. That's Econ 101.

Then it is apparent that insurance companies and any medical services/supply/devise company missed out on Econ 101.

Now if the only solution to this problem is to tax "the rich," then those are the very people who have the resources to flee to more favorable tax jurisdictions. The number of people expatriating right now has increased so much that many of these ex-pats have to wait for a year or more just to get an appointment with the local consular to sign their paperwork renouncing American citizenship.

Let them go.  If they renounce their American citizenship, then they lose their right to vote in our elections.  To renounce your American citizenship just because you refuse to pay your fair share in taxes doesn't scream "patriotism", does it?  The people who are expatriating to marvy places like the financial giant that is, say, Ireland, are doing so because they head up American companies that think that a corporate tax rate level with the personal tax rate is somehow morally outrageous.   By refusing to pay the same rate in tax that YOU pay, they are singlehandedly turning this nation in to a third world hellhole complete with a crumbling infrastructure, a broken medical system and and education system that no one would want to subject their child to.  To create a country that is worth living in, it has to be paid for, and by willingly fleeing so that you don't have to pay your fair share is morally corrupt.

Who do you think will get stuck with the bills? That's right...the middle class who can't afford to pickup and move. (The poor don't have any money by definition, so only the middle class has any money to pay taxes.) After a while then, EVERYONE is poor except the politicians.

I agree with this, but I am not sure how you can keep rich people and rich corporations from fleeing without them holding us hostage, which is essentially exactly what they are doing.  "If you don't let me pay fewer taxes than poorer people, then I'm going to take my ball and go."

[KarenInWA]

My thought is this - the rich want to renounce their citizenship???  How about those of us who were born with the crap-ass kidney card through no fault of our own??? We now get to look forward to the utmost crap in healthcare??? Because the only thing that is important in the great old US of A is profit, profit, profit, greed, greed, greed? If this is what we have to look forward to, all because the "rich" and "important" don't like to play well with others and want to stick it to the poor, sick, disabled and whomever, well, they all can go spend some special time with a big stick.  And I'm not going to go into detail on what exactly they can do with that stick...

For now, though, this will do...     

KarenInWA

[Willis]

I think the point of Mark Steyn's comments were missed. Medicare is going to change one way or the other. Either by a slow deliberate process (and yes probably very painful or even deadly for many including me) or it's going to collapse catastrophically and with no warning.

As for the ex-pats and whatever...I was just trying to point out the way things are. We can curse them all we want but it won't change things. I personally think it would be hard for me to renounce the USA (the country of my birth) even if I was rich. (Which BTW I'm not or I'd probably already have a new kidney.) But whatever the moral character of people or companies leaving the USA for tax reasons (or people who stay and just don't pay their taxes) we can't make people stay unless we use force.

American Enterprise Institute:

The wealthiest 1 percent of the population earn 19 per­cent of the income but pay 37 percent of the income tax. The top 10 percent pay 68 percent of the tab. Meanwhile, the bottom 50 percent—those below the median income level—now earn 13 percent of the income but pay just 3 percent of the taxes. These are proportions of the income tax alone and don’t include payroll taxes for Social Security and Medicare.

If one considers the percentages noted above, it is just the proverbial "cutting off your nose to spite your face" if the middle class gets stuck with paying an ever higher percentage of taxes.

I apologize for bringing politics into a dialysis thread...this can go nowhere but down. 
 

[MooseMom]

I apologize for bringing politics into a dialysis thread...this can go nowhere but down. 
 

No, this is an important discussion that we shouldn't have to apologize for conducting.  We are vulnerable to the changing opinions and the shifting demographics regarding "entitlement" programs or whatever is correct to call them.  While I realize we can't change the world on IHD, we can't just sit back and let other people make decisions for us without us speaking up for what we need.  I don't fundamentally disagree with anything you've said.  I think we all know that Medicare has to respond to the demographic changes ahead, but our representatives can't just pander to today's voters.

Nothing is going to help unless the cost of health care can be beaten back, and I see no sign of that happening at all.  If anything, health care is getting MORE expensive, and I confess I don't understand why.  Is it just the new geegaws we're convinced we need?  Is it the rising cost of keeping people alive at whatever cost for however long because we can't tell the difference between prolonging live and prolonging suffering?  I don't know.  But I can't help wondering if healthcare in the US is just a license to print money...

Thanks, Willis, for a thoughtful discussion.  I always appreciate the views of other people because they invariably see something that I have missed!  I'd be interesting in anything else you have to say on the matter.

[plugger]

American Enterprise Institute:

The wealthiest 1 percent of the population earn 19 per­cent of the income but pay 37 percent of the income tax. The top 10 percent pay 68 percent of the tab. Meanwhile, the bottom 50 percent—those below the median income level—now earn 13 percent of the income but pay just 3 percent of the taxes. These are proportions of the income tax alone and don’t include payroll taxes for Social Security and Medicare.

While on the subject of taxes I'll note the top tax rate was 70% to 90% during the '50s and '60s - now it has been 35% for most of the last decade.  Seem to recall we were booming during the '50s and '60s:
http://mjperry.blogspot.com/2009/03/90-tax-rate-back-to-1950s.html

But getting back to Medicare and single-payer, I'll just add the Congressional Budget Office and other organizations have been saying since the '90s single-payer (Medicare for All) would actually save money:

http://www.pnhp.org/facts/single_payer_system_cost.php?page=1

The ryan plan looks to me to do to Medicare what has been done to Medicare Advantage:
http://www.pnhp.org/news/2007/december/curbing_medicare_adv.php

We should be talking about expanding Medicare, rather than these attempts to kill it.

[paul.karen]

We need to stop borrowing money like we are to pay our bills.

We have PLENTY of revenue coming in to the USA.  But we need to cut SPENDING all around.  Pretty simple concept.

In your own home do you borrow money to purchase a new car?  Or leave within y9our means.

In your own home do you overextend your credit to go on a long weekend trip.  Maybe alot of us do and we deserve it.  But do we do it every other weekend?  No we live within our means.

We need to CUT SPENDING all the stupid spending like cowboy poetry-bridges to nowhere-tunnels to Manhattan that arnt needed.  Stop letting politicians use public cars they can use there own like we do.  We keep throwing billions at our school systems even though it is proven over and over that tests scores where we send this money have been flat or getting worse since the 70's.  Spending money isnt a fix.

We have to much repetition in government.  Which causes much waste.
We have the money (revenue) coming in.  We just need to stop spending on stupid things,  But our president thinks it is best to keep spending and keep borrowing money to pay OUR OLD LOANS while making NEW LOANS in the process.  This is not fiscal responsibility.  If you cant pay for it DONT GET IT/USE IT.

[Willis]

If anything, health care is getting MORE expensive, and I confess I don't understand why.

Certainly there are no easy answers to something so complex. But that never stopped me from offering an opinion! 

Now I think the problem goes way back to World War 2 era. During the war wages and salaries were capped and that's when companies first started adding health care benefits as a way of increasing wages without violating the freeze. What that did was hide health care costs much in the way that withholding hides the cost of taxes. So out of sight out of mind...I don't care what the doctor wants to do because I'm not (seemingly) paying for it...

I can tell you from experience that when the direct costs of one's health care comes out of your own pocket that you WILL ration your own care as much as possible. I have a benign cyst that is quite painful at times but every time I consider the $10,000 it would cost to remove I just say no. And consider something like a little toe fungus. I asked about those pills advertised on TV and found they were something like $10 per pill and I'd have to take them every day for who knows how long. Nah...I'll just live with it. People with insurance would have spent the money for both the procedure and the pills without blinking an eye because after all it ain't my money! (But it is hidden in the costs of everyone's wages.)

Imagine if you could only get your car insurance through your employer...what a mess that would become and it wouldn't take long for rates to skyrocket.

 

[cariad]

We need to stop borrowing money like we are to pay our bills.

We have PLENTY of revenue coming in to the USA.  But we need to cut SPENDING all around.  Pretty simple concept.

In your own home do you borrow money to purchase a new car?  Or leave within y9our means.

In your own home do you overextend your credit to go on a long weekend trip.  Maybe alot of us do and we deserve it.  But do we do it every other weekend?  No we live within our means.

We need to CUT SPENDING all the stupid spending like cowboy poetry-bridges to nowhere-tunnels to Manhattan that arnt needed.  Stop letting politicians use public cars they can use there own like we do.  We keep throwing billions at our school systems even though it is proven over and over that tests scores where we send this money have been flat or getting worse since the 70's.  Spending money isnt a fix.

We have to much repetition in government.  Which causes much waste.
We have the money (revenue) coming in.  We just need to stop spending on stupid things,  But our president thinks it is best to keep spending and keep borrowing money to pay OUR OLD LOANS while making NEW LOANS in the process.  This is not fiscal responsibility.  If you cant pay for it DONT GET IT/USE IT.

I was going to stay out of this, but Paul, when it comes to public schooling you have absolutely NO IDEA what you are talking about. None.

Our schools have been cutting back for years. There is no where left to cut, yet Governor Wanker wants to cut nearly a billion a year from the state school system. In our school alone, we have a professional called a Math Teacher Leader who raised math scores 20% in the time she was there. Her position has got the chop. We also have one of the few school libraries in the city, and it is bilingual. That collection has been built up over the past decades, is worth tens of millions, and our librarian position will also be gone next year. That library is an investment that the state made, and now they are going to walk away from it over the price of employing a librarian. It has not been proven at all that 'where we send money the test scores have been flat' or whatever it is you wrote. For fans of the constitution, our state constitution says EXPLICITLY in plain English that all kids in the state have a right to a basic education that includes music, foreign language, art and physical education. This budget forces schools to break the law. It is just that simple. And anyone who has kids will tell you that there is much more to a child's education than test scores. Eliminate public education, which is Wanker's ultimate goal, and you will eliminate the middle class, turning America into a third world country. Have you priced a private school tuition recently? I have! Only the ridiculously wealthy will be able to afford an education for their kids.

Oh, and by the way, yes, I do borrow money to buy a car. So do most people. And that is how many car companies make their money.

As for the rich threatening to leave, let them. Most of them are bluffing. Wasn't Rush Limbaugh supposed to be down in Costa Rica by now? There are plenty of wealthy people who have no problem paying higher tax. I am related to some of them. I have never heard Bill Gates or Warren Buffet whine about tax. This happens in Britain, too, wealthy people threaten to leave. Andrew Lloyd Weber was one, and I heard a British commentator sarcastically say something to the effect of "I guess I shall survive never hearing one of his dreadful pieces of music again". He was ready to purchase Andrew's single plane ticket to the continent for him.... I believe Andrew still resides in England, by the way.

If we have PLENTY of revenue, then we would not need to borrow. We don't. Cutting education spending is only going to make matters worse. Raising taxes on people who make billions is not going to hurt them and will certainly help the country. We had this conversation with our friend over the weekend, the special ed teacher who is obviously just a greedy monster with his cooler full of drinks that he all but begged us and the kids to share. Why is it never enough for some people? I for one cannot stand David Beckham - the guy has millions, and he goes to LA and feeds off the little kids who dream of playing soccer and does the absolute bare minimum to collect his paycheck. (Sorry for the example, MM) The special ed teacher talked about how Walmart employees were the single largest users of Medicaid in our country. (Perhaps they still are). Upon hiring, rather than discuss benefits like most large employers would, they give their employees information on how to collect Medicaid. The Waltons are some of the richest people in the country, but it just isn't enough for them. (Watch Walmart: The High Cost of Low Prices for further ghastly information on that company.)

[paul.karen]

Im glad i could get you into the discussion Cariad.

All school districs are different.  Here in Jersey we yearly keep throwing money MORE AND MORE money to school districts that are getting worse and worse test scores prove this not me.  Usually inner city schools where the drop out rate is over 50% before graduation.  What i am saying is THROWING MORE money at these schools has pr oven not to help.

I'm all for paying good teachers more money, let the teachers if there good benefit. Here in jersey a teacher CANT be fired tenour.  Once (some) teachers reach tenure they kinda give up or have maybe lost hope.  I mean they get there raise needless of how well they teach or dint teach.
There is a teacher in NYC who has been suspended with pay for YEARS.  He still has to go to school but he sits in a private room in a non teaching non student contact way.  While he collects his teacher salary he also uses his computer to run his very successful Realtor business during school hours.  You back this kind of thing>  You back bad teachers making the same as a teacher like your speacial ed teacher who goes above and beyond?  Dont try to make it sound like im against education and or teachers.  I think we need to make pay based on merit and proven teaching ability.

Im all for teachers im all against tenure when you cant fire a proven bad teacher.

I thought Obama fans were all about change?  How is doing the same thing year after year change??  Money doesnt fix problems, people fix problems.

[Jie]

We are discussing health care, not education cost. The Fed. education cost is a drop of water in the Ocean, relative to other costs. The problem of the education is more a family and cultural problems than money, anyway. Bringing our troop back from the Middle East will save a lot more than the Fed. education cost. Like Willis said, some personal and family responsibility is needed to reduce the health care cost, especially for the elderly end of life care. I hope both parties can come together to get a solution, rather than scoring political points.

[MooseMom]

Certainly there are no easy answers to something so complex. But that never stopped me from offering an opinion! 

Now I think the problem goes way back to World War 2 era. During the war wages and salaries were capped and that's when companies first started adding health care benefits as a way of increasing wages without violating the freeze. What that did was hide health care costs much in the way that withholding hides the cost of taxes. So out of sight out of mind...I don't care what the doctor wants to do because I'm not (seemingly) paying for it...

I can tell you from experience that when the direct costs of one's health care comes out of your own pocket that you WILL ration your own care as much as possible. I have a benign cyst that is quite painful at times but every time I consider the $10,000 it would cost to remove I just say no. And consider something like a little toe fungus. I asked about those pills advertised on TV and found they were something like $10 per pill and I'd have to take them every day for who knows how long. Nah...I'll just live with it. People with insurance would have spent the money for both the procedure and the pills without blinking an eye because after all it ain't my money! (But it is hidden in the costs of everyone's wages.)

Imagine if you could only get your car insurance through your employer...what a mess that would become and it wouldn't take long for rates to skyrocket.

I agree with all of this.  Linking health insurance with your employment may have been a good idea at the time, but today, it is cumbersome because it traps both employees and employers.  Employees are not free to pursue jobs they might prefer because they may lose out on insurance, and providing health insurance to your workers is a huge business expense for employers.

I wholeheartedly agree that patients need to look at the costs of their medical care, but patients often don't get that chance.  We are told that we need to exercise personal responsibility, but we don't get the chance because there is someone there in the middle (medicare or an insurance co bureaucrat) making decisions for us.  And then there are the doctors who will order every test imaginable so that they can either cover their own butts or else make an extra buck.  I had a routine procedure 4 years ago, and the results were all fine.  It was not kidney related.  TWO MONTHS LATER, I saw my neph for a routine appt, and the practice secretary came in and said that they were waiting for approval from my ins co so that they could give me a referral for another test.  This was the first I had heard about it!!!  Apparently the other doc had noticed some "thickening" in my colon and wanted to send me into Chicago for some fancy-assed test AND HAD NEVER DISCUSSED IT WITH ME!!!  I flatly refused because no one could tell me why this would be worth the cost.

I take a mountain or prescription drugs and insist upon the generic form of each when available.  My neph is down with that. 

I am on the transplant list and have to send in a blood sample EVERY MONTH.  No one can tell me why, only that it is IMPORTANT.  My blood type is not gonna change every month, and neither is my HLA.  But I'm told that they have to test my PRA each month to ensure a good match should a kidney become available, but the things that vastly change your PRA are pregnancy (not gonna happen),  transfusion (I'm not so stupid that I wouldn't tell my transplant center I didn't have a transfusion in the last month) or a transplant (I wish).  So again, why are the 80,000 on the transplant list having to spend the money to send in blood each month?  The manpower it takes to assemble those little boxes each month and send them out must be enormous, and I don't understand it.  So really, to me it's like printing money. 

If you're on dialysis, do you know the cost of every little component of every treatment you get?  What's the cost of the disinfectant they use on the chairs?  How much do the techs get paid?  Who pays for their uniforms, and how much?  Do you, Spongebob the Dialysis Patient, get a say in how to manage the cost of your meds or dialysate or any and every little item used on you?  While most people can certainly have a say in how much some of their health care costs, on the whole I'm not sure we have as much say as we might like. 

[cariad]

Im glad i could get you into the discussion Cariad.

Aw, Paul, now I want to hug you.

All school districs are different.  Here in Jersey we yearly keep throwing money MORE AND MORE money to school districts that are getting worse and worse test scores prove this not me.  Usually inner city schools where the drop out rate is over 50% before graduation.  What i am saying is THROWING MORE money at these schools has pr oven not to help.

I'm all for paying good teachers more money, let the teachers if there good benefit. Here in jersey a teacher CANT be fired tenour.  Once (some) teachers reach tenure they kinda give up or have maybe lost hope.  I mean they get there raise needless of how well they teach or dint teach.
There is a teacher in NYC who has been suspended with pay for YEARS.  He still has to go to school but he sits in a private room in a non teaching non student contact way.  While he collects his teacher salary he also uses his computer to run his very successful Realtor business during school hours.  You back this kind of thing>  You back bad teachers making the same as a teacher like your speacial ed teacher who goes above and beyond?  Dont try to make it sound like im against education and or teachers.  I think we need to make pay based on merit and proven teaching ability.

Im all for teachers im all against tenure when you cant fire a proven bad teacher.

I thought Obama fans were all about change?  How is doing the same thing year after year change??  Money doesnt fix problems, people fix problems.

You're right, all school districts are different, and I am fast becoming an expert on Wisconsin. As I've said in another thread, we could fix our problem in Wisconsin with a 1% increase in sales tax, which would not only apply to everyone fairly equally and in a way that the individual can control, but will also let the tourists help the problem. Yes, tax increases can do this.

Obama is not really involved in our local education fight, but what makes you think we are just doing the same thing? I would like to see no child left behind axed because it is detrimental - parents complain that their kids are not learning but are being passed anyway. That is craziness. I have yet to meet a teacher of either one of my sons - public, private, charter, we've seen them all - who I would describe as lazy, greedy or incompetent. There have been one or two I do not like. There is a student teacher who teaches my younger son whom I have some issues with, but I can promise you she is not getting into teaching for the money. I am glad you are all for paying teachers. Jie is right that the federal money for education is microscopic in the scheme of things, though I do not like to be lectured about going off topic by him, especially because if we are talking about where else to cut and education comes up, I am going to say something. Federal dollars that come to us in Wisconsin are for special programs for the impoverished - it is very small, and if it is cut you will see kids going without food. Most parents in the state of Wisconsin, including me, start to foam at the mouth when education cuts are mentioned. We are really being pushed too far, and I am fairly certain Wanker will pay for this with his political career.

And of course the Medicare/Medicaid foe is coming out of Wisconsin as well. (hangs head in shame while reminding others that I spent most of my life in other states/countries). I think the same of Medicare/Medicaid as I do about education - take away access to these basics from the poor and much of the middle class, and we turn into a third world country. I've been to third world countries and there is a reason that they battle problems like widespread violence, abductions for ransom, children sold as soldiers or prostitutes - people turn to these desperate measures when they have nothing to lose and very much to gain. I am worried about this country. How much can the far right push people around and make it clear that they respect nothing about humans but their income before there is widespread revolt? Yes, I agree that Medicare needs to be reformed, and I agree with MM that cost control is a must. That just might mean telling a few giant corporations that they are not allowed to charge $1000/prescription anymore. From what I have read, doctors salaries, while quite high, are not the problem and capping those would do little to help us. Prevention is cheap, intervention and treatment is expensive - we need to give EVERYONE affordable access to preventative health care which will also help to reduce costs. My husband's company gives incentives for having annual physicals and i am fine with that. He can go to his own doctor, fill out a quick form, and he won't have to pay a higher premium on insurance. This is a small way that they can get their employees to at least engage in a minimum of preventative care. Decoupling health insurance from employment is crucial and universal healthcare would do that.

PS- I am doped up on painkillers at the moment thanks to a brutal viral infection, so if this makes little sense or is repetitive, let's blame the oxycontin.

[plugger]

Bringing our troop back from the Middle East will save a lot more than the Fed. education cost.

Funny, we aren't talking more about that!  Never enough money for health care and education, but always enough money to trounce nations with WMDs (Weapons of Mass Distraction).

[plugger]

But getting back to the ryan plan, the Congressional Budget Office had this to say:

Long-Term Analysis of a Budget Proposal by Chairman Ryan

Congressional Budget Office
April 5, 2011

A private health insurance plan covering the standardized benefit would, CBO estimates, be more expensive currently than traditional Medicare. Both administrative costs (including profits) and payment rates to providers are higher for private plans than for Medicare. Those higher costs would be offset partly but not fully by savings from lower utilization stemming from two sources. First, private health insurers would probably impose greater utilization management than occurs in Medicare. Second, private plans might restrict enrollees’ ability to purchase supplemental insurance plans; enrollees would thus face higher out-of-pocket costs than they do in Medicare, and that increased cost sharing would encourage lower utilization. On net, for a typical 65-year-old in 2011, CBO estimates that average spending in traditional Medicare will be 89 percent of (that is, 11 percent less than) the spending that would occur if that same package of benefits was purchased from a private insurer.

http://www.pnhp.org/news/2011/april/cbo-medicare-privatization-would-increase-costs